Insertion time

Abstract: Two hundred and fifty-two women scheduled to undergo laparoscopy were randomly assigned to a Verres needle or direct insertion group. The groups were similar with respect to incidence of obesity, prior surgical treatment, indication for operation and level of training of the surgeon performing the procedure. There were no major complications associated with either technique. Minor complications (preperitoneal insufflation, failed entry or more than three attempts necessary to enter the peritoneal cavity with the trocar) were significantly more frequent (p < 0.05) in the Verres needle technique group. One hundred and thirteen of these patients underwent sterilization procedures. The mean times for performance of the laparoscopic procedure using the direct insertion and Verres needle techniques was 15.3 and 19.6 minutes, respectively. The time saved using the direct insertion technique is explained by a significant (p < 0.01) reduction in the mean laparoscope insertion time, which was 2.2 minutes and 5.9 minutes for the direct insertion and Verres needle techniques, respectively. We prefer the direct insertion technique for trocar placement because it has fewer minor complications and requires less operating time.

Abstract: Background: This study compared the ease of insertion of the laryngeal mask airway (LMA™) with a partially inflated cuff using the standard `nonrotational' technique versus the rotational technique. Methods: One hundred and forty-five children undergoing anaesthesia using the LMA were randomly assigned to either method. The cuff was partially inflated in both groups. The ease of insertion was assessed by the time taken to complete the LMA insertion, the number of attempts before successful placement and the occurrence of complications. Results: The success rate of insertion at the first attempt was higher in the rotational technique group (99% versus 79%, P < 0.05). All patients in the rotational group had the mask inserted within two attempts. On the other hand, three patients had the mask inserted on the first attempt with the rotational technique after three unsuccessful attempts by an anaesthesiologist with the standard `nonrotational' technique. Insertion technique made no difference on insertion time. Conclusions: The rotational technique was associated with a higher success rate for insertion and a lower incidence of complications in children. Using the rotational technique with a partially inflated cuff could be the first-choice approach in paediatric patients.

Abstract: Accurate placement of an external ventricular drain (EVD) for the treatment of hydrocephalus is of paramount importance for its functionality and in order to minimize morbidity and complications. The aim of this study was to compare two different drain insertion assistance tools with the traditional free-hand anatomical landmark method, and to measure efficacy, safety and precision. Ten cadaver heads were prepared by opening large bone windows centered on Kocher’s points on both sides. Nineteen physicians, divided in two groups (trainees and board certified neurosurgeons) performed EVD insertions. The target for the ventricular drain tip was the ipsilateral foramen of Monro. Each participant inserted the external ventricular catheter in three different ways: 1) free-hand by anatomical landmarks, 2) neuronavigation-assisted (NN), and 3) XperCT-guided (XCT). The number of ventricular hits and dangerous trajectories; time to proceed; radiation exposure of patients and physicians; distance of the catheter tip to target and size of deviations projected in the orthogonal plans were measured and compared. Insertion using XCT increased the probability of ventricular puncture from 69.2 to 90.2 % (p = 0.02). Non-assisted placements were significantly less precise (catheter tip to target distance 14.3 ± 7.4 mm versus 9.6 ± 7.2 mm, p = 0.0003). The insertion time to proceed increased from 3.04 ± 2.06 min. to 7.3 ± 3.6 min. (p < 0.001). The X-ray exposure for XCT was 32.23 mSv, but could be reduced to 13.9 mSv if patients were initially imaged in the hybrid-operating suite. No supplementary radiation exposure is needed for NN if patients are imaged according to a navigation protocol initially. This ex vivo study demonstrates a significantly improved accuracy and safety using either NN or XCT-assisted methods. Therefore, efforts should be undertaken to implement these new technologies into daily clinical practice. However, the accuracy versus urgency of an EVD placement has to be balanced, as the image-guided insertion technique will implicate a longer preparation time due to a specific image acquisition and trajectory planning.

Abstract: BACKGROUND The i-gel is a newly developed, cuffless and single-use supraglottic airway device with gastric drain conduit. This study was designed to compare the performance of the i-gel with the reusable LMA Proseal when used during anesthesia in spontaneously breathing adult patients. METHODS One hundred adult patients were studied in a prospective randomized controlled study. Insertion time, success rate at the first attempt, necessity for finger insertion along with the device, leak pressure, success rate for gastric tube placement, and the incidence of blood staining on removal, sore throat and hoarseness were compared. For statistical analyses, Student's t test, Mann-Whitney's U test, and Fisher's exact test were used where appropriate, and P<0.01 considered significant. RESULTS I-gel provided significantly faster insertion time (4.4 vs 16 seconds, P < 0.01). Success rates were higher for i-gel, and i-gel requiring no finger insertion with the device. Leak pressure was similar just after insertion, but higher for i-gel after 10 minutes from insertion (36 vs 28 cmH2O, P < 0.01). Success rate for gastric tube placement and the incidence of complications were similar. CONCLUSIONS Our result indicated that i-gel can be inserted faster without inserting practitioners' finger into patient oral cavity. Leak pressure was sufficient for clinical use in spontaneous breathing anesthetized adult patients.